AAP: Poverty Threatens Children’s Health

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The American Academy of Pediatrics (AAP) is recommending that pediatricians include a question about poverty to their wellness exams. Many experts agree, and studies support, that poverty can have a major impact on a child’s heath.

The AAP’s new recommendation states that pediatricians should start assessing children for their poverty status. The screening begins with a single question — asking parents whether they have difficulty in making ends meet at the end of the month.

According to the National Center for Children in Poverty (NCCP), there are more than 16 million U.S. children (22% of all children) living below the federal poverty level of $23,550 a year for a family of four.

Growing evidence suggests that the stress of not having safe and secure housing, regular meals and a stable home environment can lead to significant health problems in children.

“We know children living in poverty have more chronic disease, more severe chronic disease, and have poor early brain development which can impact them when they get to school, and lead to poor academic performance,” says Dr. Benard Dreyer, president of the AAP. “Pediatricians deal on a daily basis with the intersection between poverty and health and the well being of children. They understand that they actually aren’t separate.”

The recommendation offers a process to make it easier for doctors who aren’t sure about how to address the issue. The screening doesn’t have to be performed by the doctor, but can be part of a checklist that parents fill out while waiting for their well child visit, or, in larger practices, could be conducted by a quick interview with office staff or social workers.

Pediatricians are also given guidelines to help connect financially struggling families with the proper resources to help them find local housing bureaus, food pantries and even job listings. The hope, says Dreyer, is to help the 50% of families who currently qualify for additional support but aren’t getting it to access the resources they need. “Many pediatricians are already doing this, and helping families who have been evicted or connecting them to local food pantries. What we want to do is to give them more resources,” says Dreyer.

Children in deep poverty, whose family income is below 50 percent of the federal poverty line, do even worse on health and development indicators than children in poverty according to a study released by the National Center for Children in Poverty (NCCP) at Columbia University's Mailman School of Public Health. The study compared the wellbeing of children in deep poverty to children that are poor, but not in deep poverty, and to non-poor children.

The worse off the family’s financial situation is, the more likely a child will suffer from health and developmental problems such as stress, anxiety, obesity and elevated lead levels.

With the recommendation, the academy is also urging state and federal lawmakers to expand existing housing, food and health programs. “In order for kids to thrive, we recognize that the community, family and social aspects of their existence may be even more important than many of the medical things they may be dealing with,” says Dreyer. “Poverty is the most serious non communicable disease that children have — and it’s the most common.”

AAP Supports Flu Shots Instead of Nose Spray for Children

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The American Academy of Pediatrics (AAP) says that health care providers should not use the live attenuated influenza vaccine (LAIV) in the upcoming 2016-’17 flu season due to poor effectiveness. The LAIV is the nasal spray version of the annual flu vaccine.

Instead, the AAP recommends health care providers use the inactivated vaccine given by injection for flu prevention in children.

Academy leaders say they support the interim recommendation released this week, by the CDC’s Advisory Committee on Immunization Practices (ACIP).

“We agree with ACIP’s decision today to recommend health care providers and parents use only the inactivated vaccine for this influenza season,” said AAP President Benard Dreyer, M.D., FAAP.

Health officials reported Wednesday that the spray performed dismally for the third straight year, while the traditional flu shot — the one that stings — worked reasonably well this winter.

“We could find no evidence (the spray) was effective,” said Dr. Joseph Bresee, a flu expert at the U.S. Centers for Disease Control and Prevention (CDC).

The AAP recommends children ages 6 months and older be immunized against influenza every year. Previously, the CDC and AAP had recommended either form of flu vaccine – the inactivated influenza vaccine (IIV) that is given by injection and is approved for all patients older than 6 months, or LAIV which is given by intranasal spray and is approved for healthy patients ages 2 through 49 years.

However, the new data presented to the ACIP showed that currently only IIV provides protection against flu. The ACIP assessed data from the past three influenza seasons and cited evidence of poor effectiveness of LAIV during this time period.

Two years ago, experts suggested health care providers use AstraZeneca’s FluMist nasal spray to protect children against the flu. This week, a federal advisory committee on immunization withdrew its endorsement of the vaccine.

“We do understand this change will be difficult for pediatric practices who were planning to give the intranasal spray to their patients, and to patients who prefer that route of administration,” said AAP CEO/Executive Director Karen Remley, M.D., M.B.A., M.P.H., FAAP. “However the science is compelling that the inactivated vaccine is the best way to protect children from what can be an unpredictable and dangerous virus. The AAP will be working with CDC and vaccine manufacturers to make sure pediatricians and families have access to appropriate vaccines, and to help pediatricians who have already ordered intranasal vaccines.”

During the winter that just ended, flu shots were nearly 50 percent effective against the flu strain that made most people sick. But FluMist didn’t work at all, CDC researchers said, citing preliminary results from a study of about 2,300 U.S. children.

Experts were particularly worried that FluMist hasn’t protected against H1N1, a type of flu that often causes more deaths and hospitalizations among children and young adults.

For now, health officials say that returning to the flu shot, instead of using the nasal spray, is the best option for preventing or minimizing the effects of the flu in children.